Cedar Rapids Community School District v. Garret F., a Minor (03/03/1999)

By: Riza Freeman, Medill News Service

Questions presented

(1) Whether a school district is required to pay for continuous one-on-one nursing services for a disabled student, when the Individuals With Disabilities Education Act expressly excludes ""medical services"" from its mandate.

(2) Whether there should be a bright-line rule that the Act's exclusion of ""medical services"" means only those services provided by a physician, or whether other medical services are excluded from the Act.

Brief

10th grader Garret Frey is a teen-ager like any other except for the fact that he needs 24-hour attention, is immobile and depends on others to help him through the day.

Garret is quadriplegic, and has been since he was four years old, as a result of a motorcycle accident. He requires a catheter, repositioning, food and drink, ventilator setting checks, respiratory and blood pressure monitoring, among other things.

After school and on the weekends, his family and a nurse care for him. But in school, Garret's disability has presented some problems.

In kindergarten, Garret's 18-year-old aunt, with no training in nursing, assisted him during the school day for one year. Since then, a licensed practical nurse has been assisting Garret, 16 hours a day, five days a week.

In 1993, Charlene Frey, Garret's mother, asked the school to provide nursing care for him during the school day. The school district in Cedar Rapids, Iowa, which had been paying for a special bus to transport him to his school, special computerized equipment and a teaching associate, refused. Frey, in turn, sued.

In September 1994, an Iowa Board of Education administrative law judge ordered the school district to reimburse Frey for the nursing expenses during the 1993-1994 school year and to provide the necessary services for Garret in the future.

Cedar Rapids Community School District appealed to the district court where the judge granted summary judgment to Garret, ruling that the services fell under the ""related services"" included by the federal Individuals with Disabilities Education Act, rather than ""medical services"" excluded under the law.

Under the IDEA, children with disabilities are entitled to a ""free appropriate public education,"" under which lies special education and related services. Thus, the 8th Circuit Court of Appeals ruled in December 1996 that under the law, the school district was obligated to provide ""related services.""

The definition of ""free appropriate education"" as detailed in the court's decision,, includes special education and related services that are provided at public expense, meet state standards, include appropriate education at all levels and are provided in ""conformity with the individualized education program.""

The court mentioned a two-pronged test to determine if a service was indeed a ""related service"": if it is a supportive service required to assist a child with a disability to benefit from special education and if it is a service excluded from medical services beyond diagnosis and evaluation.

The court also noted that ""If the services are not available during the school day, Garret cannot attend school and thereby benefit from special education."" The court mentioned the ""bright line"" test, in which the main criteria is whether services are provided by a nurse or a physician, therefore providing a distinction between medical services and school health services or supportive services.

Sue L. Seitz, an attorney for the school district, said the question comes down to the varying interpretations of ""medical services"" and that four federal circuit courts have held that a nurse's care falls under that rubric and therefore is not covered under IDEA.

Seitz said that both Garret's fund and his insurance can adequately pay for his services. In Iowa, in particular, IDEA funding is appropriated for services such as physical, speech and occupational therapy.

With the ever-increasing number of ""medically fragile"" children coming into schools from various institutions, Seitz said, the issue of what exactly is funded under IDEA has broad applicability. The annual $40,000 expenses for Garret's care could pay for one more teacher in the district.

""We're not arguing the kids should not come to school,"" Seitz said, adding that the government provides resources like Medicaid to pay.

The Cedar Rapids Community School District's petition for certiorari was granted by the U.S. Supreme Court on May 18, 1998, after the Court invited the Solicitor General to file briefs expressing the views of the United States.

On March 3, 1999, the Court, by a 7-2 vote, affirmed, holding that the IDEA requires the District to provide Garret with the nursing services he requires during school hours. Writing for the majority, Justice John Paul Stevens described Garret F. as ""a friendly, creative, and intelligent young man"" who, because of his disability, cannot remain in school without “continuous one-on-one nursing services” during the school day. Though the Court expressed sympathy for the district's legitimate concerns about the financial burden of providing the services Garret needs, it said that accepting a cost-based, multi-factor test proposed by the school district is ""not supported by any recognized source of legal authority.""

""This case is about whether meaningful access to the public schools will be assured, not the level of education that a school must finance once access is attained,"" Stevens wrote. ""It is undisputed that the services at issue must be provided if Garret is to remain in school. Under the statute, our precedent, and the purposes of the IDEA, the District must fund such 'related services' in order to help guarantee that students like Garret are integrated into the public schools.""

Justices Clarence Thomas and Anthony Kennedy dissented, criticizing the majority for disregarding ""the constitutionally mandated principles of construction applicable to Spending Clause legislation and blindsid(ing)unwary States with fiscal obligations that they could not have anticipated.""